title: Drug utilization pattern and cost for the treatment of severe sepsis and septic shock in critically ill cancer patients.
abstract: BACKGROUND
  Cancer patients are at high risk for developing sepsis. To our knowledge, there are no studies that evaluated the type of medications utilized and the associated cost in cancer patients with severe sepsis and septic shock.
  
  
  OBJECTIVE
  To describe the drug utilization pattern and drug cost in the treatment of cancer patients with severe sepsis and septic shock.
  
  
  METHODS
  12-bed medical/surgical intensive care unit (ICU) of a comprehensive teaching cancer center.
  
  
  METHODS
  A retrospective cohort study of cancer patients with severe sepsis or septic shock who were treated in the ICU between January and December, 2010. The ICU sepsis database was used to identify patients. The patient demographics and characteristics were recorded. In addition, the number and type of prescribed medications, total cost for each medication, type of infection, and culture results were determined.
  
  
  METHODS
  The main outcomes were the type of medication classes utilized and the cost of the medications.
  
  
  RESULTS
  During the study period, 116 cases were identified. Upon presentation, the mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 21.8 (SD ± 7.8), 30 (25.9 %) patients had neutropenia, and 94 (81 %) had positive cultures. The total cost of the medications prescribed for this cohort of patients was 291,030 Euro. The mean number of medications prescribed per patient and the mean total cost per patient were 11.7 (SD ± 4.7) and 2,509 Euro (SD ± 2,844), respectively. The most commonly prescribed medication classes were acid suppressive therapy, glycopeptides, penicillins/cephalosporins and vasopressors prescribed in 113 (97 %), 104 (89.7 %), 103 (88.9 %), and 102 (88 %) patients, respectively. The highest medication costs were associated with antifungals (mean 1,288 Euro/patient) and colony stimulating factors (mean 829 Euro/patient), prescribed in 55 (47.4 %) and 37 (31.9 %) patients, respectively. Medication costs were higher in non-survivors, compared to survivors (3,664 Euro vs. 1,430 Euro, p = 0.0001), and in patients with positive cultures, compared to patients with negative cultures (3,198 Euro vs. 1,865 Euro, p = 0.0004).
  
  
  CONCLUSIONS
  In cancer patients with severe sepsis and septic shock, multiple medications are prescribed which are associated with high cost.
authors.affiliation: Department of Pharmacy, King Hussein Cancer Center, Queen Rania Al-Abdallah Street, P.O.Box 1269, Amman, 11941, Jordan, lnazer@khcc.jo.
authors.forename: Lama
authors.initials: L
authors.lastname: Nazer
authors.forename: Mohammad
authors.initials: M
authors.lastname: Al-Shaer
authors.forename: Feras
authors.initials: F
authors.lastname: Hawari
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D002173:Cancer Care Facilities; D015331:Cohort Studies; D016638:Critical Illness; D016527:Drug Costs; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D007597:Jordan; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000191:economics; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy* / Q000191:economics / Q000209:etiology; D012772:Shock, Septic / Q000188:drug therapy* / Q000191:economics / Q000209:etiology; D017741:Survivors